Basic Information
| Provider Information | |||||||||
| NPI: | 1720037799 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH VISTA HOSPITAL LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTH VISTA HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1409 E LAKE MEAD BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890307120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026497711 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1409 E LAKE MEAD BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890307120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026497711 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DOAN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING ASSOCIATE GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 3102594706 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 649HOS12 | NV | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0381966 | 05 | OH | MEDICAID | 100502299 | 05 | NV | MEDICAID | 100502300 | 05 | NV | MEDICAID | 2000051340A | 05 | OK | MEDICAID | 913275900 | 05 | FL | MEDICAID | 200327790A | 05 | KS | MEDICAID | 33224871 | 05 | CO | MEDICAID | 48475254 | 05 | NM | MEDICAID | XHSP33711 | 05 | CA | MEDICAID | 100502301 | 05 | NV | MEDICAID | 1704989 | 05 | LA | MEDICAID | 2900005 | 05 | NC | MEDICAID | 645868 | 05 | AZ | MEDICAID | 807122600 | 05 | IA | MEDICAID | 304744870 | 05 | MI | MEDICAID | XHSP43711 | 05 | CA | MEDICAID | 752632600 | 05 | MI | MEDICAID |